There are several socially stigmatized conditions, such as physical illness or poverty, 42 , 43 that are also likely to lead to distress. Sexual relationship disorder describes a clinical syndrome in which an abnormal sexual preference or gender identity makes it difficult to form or maintain a relationship with a sexual partner.
Generally ICD diagnoses reflect individual-level disturbances but the disturbance in sexual relationship disorder is dyadic by definition. Difficulties in relationships with sexual partners are commonplace and occur for many reasons. Moreover, ICD does not include a classification for relationship disorders due to other potentially contributory factors.
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There is no justification for creating a mental disorder category that is specifically based on the co-occurrence of relationship problems with sexual orientation or gender identity issues. Though ICD does not define what constitutes a psychosexual developmental disorder, sexual orientation is clearly central to the concept given its prominence in the F66 categories. A major concern is that this category gives no specific information about what is being treated, nor does it indicate what might be appropriate treatment. Rather, it appears to provide an opportunity to apply an undefined mental disorder diagnosis to individuals with a same-sex orientation.
In particular, we comment on their clinical utility, their use for public health surveillance and the negative consequences of their retention. Clinical utility is enhanced when diagnostic categories provide useful information, are commonly understood by health-care providers and help select appropriate and effective interventions. How are lesbian, gay and bisexual people currently treated in mental health care settings? S urveys of mental health practitioners in the United Kingdom of Great Britain and Northern Ireland and the United States of America reveal that the great majority have experience treating individuals with a same-sex orientation.
Instead, however, it appears that people with a same-sex orientation typically receive treatment for common mental disorders, such as depression, anxiety disorders and problems with substance use. In the lone study of the content of common worries among people with a same-sex orientation, concerns about sexual orientation were relatively uncommon. One argument for retaining the F66 categories is that they may improve diagnostic accuracy because they can be used for individuals who present with concerns about sexual orientation or gender identity. For example, some practitioners may see sexual relationship disorder or sexual maturation disorder as an alternative diagnosis to a gender identity disorder.
However, it is not clear that assigning additional or alternative categories based on sexual orientation actually improves diagnostic accuracy, particularly given the problems with validity described above. On the contrary, the existence of these categories may be harmful because they draw attention to content e.
In a search of Medline, Web of Science and PsycINFO databases, the Working Group found that the categories of sexual maturation disorder and sexual relationship disorder had generated no scientific publications as of 10 January publications.
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In addition, a literature search revealed no references to evidence-based treatment for F66 disorders. Moreover, there was no evidence that concern about gender identity or sexual orientation requires unique interventions that are substantially different from the common methods of treating distress, anxiety, depression and other mental disorders. The best clinical care for people with a same-sex orientation does not differ from that for their heterosexual counterparts. On occasion, the argument is raised that the F66 categories might offer protection for people with a same-sex orientation in some countries.
Currently, the Working Group is aware of six countries where same-sex sexual behaviour may be punishable by death. It has been argued that classifying some forms of same-sex sexual behaviour as mental disorders can protect individuals from execution for homosexuality via a mental disorder exemption. However, the Working Group was unable to establish whether such a defence has actually been used, despite sporadic executions for homosexuality in recent years. Further, retaining the F66 categories for this purpose alone is both inconsistent with human rights principles and the governing purpose of the ICD.
An important role of the ICD is that it provides a common means of public health surveillance internationally. However, the F66 categories contribute little, if anything, to surveillance. Retaining the F66 categories may create unnecessary harm. Individuals with a same-sex orientation may receive suboptimal care because use of these categories may lead to mistakes or delays in accurate diagnosis and treatment. This included masturbation, "fornication," bestiality, and oral or anal sex whatever the sex of the participants.
Most commonly it referred to anal sex between men. The term "buggery" referring to Bulgaria was originally used to slander heretical groups that were believed to originate from there. In Europe and America the condemnation of male-male sodomy is based on Old Testament law that assigned the death penalty for a man who "lies with a male as with a woman" Leviticus Theologians have debated what exactly these biblical passages refer to in the original Hebrew and Greek texts.
Through the Middle Ages, ecclesiastical courts were charged with trying cases of "sodomy" most commonly pursued when heretical or anti-church activity was also suspected. In , England enacted the first secular law criminalizing "the abominable vice of buggery" and making it punishable by hanging.
The English colonies in America adopted English law against sodomy or, as in case of Plymouth, Massachusetts Bay, Connecticut, New Hampshire and Rhode Island colonies, simply cited Leviticus as the basis for establishing sodomy as a capital offense. The European decriminalization of sodomy began in post-Revolutionary France. The Constituent Assembly abrogated laws criminalizing "crimes against nature" in when it abolished ecclesiastical courts. This followed from the broader spirit of Enlightenment legal reform that protected the private sphere from state intrusion.
The public and minors were still deemed to require state protection; therefore, the Law of July and the Napoleonic Penal Code of criminalized "debauchery or corruption" of minors of either sex and "offenses against public decency" including sex in public places such as parks or bathrooms. Men arrested under suspicion of public sex were subjected to medical examinations to help determine if anal sex had taken place. Therefore, medico-legal experts were the first to become interested in the scientific study of sexuality in the 19th century.
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Tardieu argued that penile and anal physical stigmata invariably betrayed inveterate sodomites. Furthermore, he suggested there were psychological and behavioral traits such as effeminacy and cross-dressing , that betrayed a subset of exclusive sodomites who he believed suffered from a form of insanity.
The medical literature on homosexuality that grew rapidly in the late 19th century was largely written by medico-legal experts concerned with determining whether certain people accused of criminal sexual behavior should be considered innocent because of a constitutional defect or mental illness.
Although such pathologization may seem stigmatizing, at the time it could also serve liberatory aims since it wrested the issue of sodomy from the police and courts. German lawyer Karl Heinrich Ulrichs was perhaps the first activist for homosexual civil rights. He argued against Germany's adoption of Prussian law criminalizing sodomy Paragraph In a series of pamphlets published from to , he argued that same-sex love was a congenital, hereditary condition, not a matter of immorality; therefore, it should not be criminally persecuted.
He called himself and those like him " Urnings " who had a female soul in a male body. He hypothesized that there were competing male and female "germs" that determined male and female anatomy and psyche. Ulrichs proposed that Urnings were a form of psychosexual hermaphrodites.
Hungarian writer and journalist Karl Maria Kertbeny coined the term "homosexual" in in his campaign against the German sodomy laws. Like Ulrich, he argued that homosexual attraction was innate, but did not believe all homosexuals were psychologically effeminate. Ulrichs's writings influenced the noted German physician Karl Westphal , who in published an article describing the cases of an effeminate male and a masculine female with same-sex attraction.
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He called the condition "contrary sexual sensation" and claimed it was congenital. As such, he argued, it should come under psychiatric care rather then legal prosecution. Westphal's diagnosis was rendered into Italian by forensic expert Arrigo Tamassia as "inversion of the sexual instinct" The celebrated French neurologist Jean Martin Charcot rendered it into French in as "inversion of the genital sense" in an article describing a variety of "sexual perversions" including inversion and fetishism. Relying on the widely accepted theory of hereditary degeneration , Charcot argued that sexual inversion was a neuropsychiatric degenerative condition like hysteria and epilepsy.
As such, he believed it was a serious mental illness likely to be associated with other disorders. Other German forensic writers followed Westphal's lead, most notably Richard von Krafft-Ebing A Medico-Forensic Study was first published as a small booklet and then vastly expanded over the years into an encyclopedia of sexuality.
Krafft-Ebing introduced many terms into the medical nosology such as "sadism" and "masochism. Krafft-Ebing initially presented homosexuality as a severe manifestation of hereditary degeneration, but late in his life, after having met many homosexuals, he argued that they could be perfectly respectable and functional individuals.
He was a political liberal who argued against sodomy laws and testified in the defense of homosexuals. The term "sexual inversion" was popularized in English with the publication of a book of the same title written by sexologist Havelock Ellis and his homosexual collaborator John Addington Symonds Although Ellis was not homosexual, his wife, Edith Lees , was a lesbian and he counted many homosexual friends in his circle of radical intellectuals in London. Ellis believed homosexuality was a congenital variation of sexuality and not a disease.
The notion of sexual inversion continued to dominate medical thinking about homosexuality into the twentieth century as biomedical researchers employed the latest techniques to uncover its biological basis. Even before sex hormones were discovered, homosexuals were hypothesized to be neuro-endocrinological hermaphrodites. This was the preferred hypothesis of German sexologist Magnus Hirschfeld Hirschfeld was perhaps the first physician who was public about his own homosexuality and was a tireless advocate for homosexual rights.
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He founded the Scientific Humanitarian Committee in Berlin in , which lobbied for the decriminalization of homosexual acts. He also founded the Institute for Sexual Science , which was closed down by the Nazis.
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